Outline

Background and Aim

The high and increasing prevalence of diabetes mellitus type 2 and the high proportion of treatment costs in patients with diabetes on the total health costs were the background to analyse the expenditures for diabetic patients of a general practice. Aim of the study was to verify pattern of prescription and medical measures in context to clinical findings and to find out potentials for cost savings.

Material and Method

A case-control-study in 103 patients with diabetes mellitus type 2 and a mean age of 65 years as well as 412 control patients without diabetes matched by age and sex was performed. Demographic, medical and economic data were analysed over a period of 12 months (04/98-03/99). Data recording based on the database and the archive (patients records) of the general practitioner including hospital discharge reports, findings of specialists, accounting data as well as on data of the "Statistisches Bundesamt". Various characteristics were tested by multiple regression analysis regarding their influence on the main cost factors.

Results

The total costs of diabetic patients amounted to 5701 DM per patient and year versus 2878 DM in the control group. Hospitalisation was the main costs factor in both, diabetics and non-diabetics (44% = 2518 DM and 46% = 1319 DM, respectively). The diabetes itself was the cause for admission in one case only. Drug prescriptions caused 24% and 21% (1357 DM and 606 DM) of the total costs. Significant higher costs per patient existed in the ATC group A (alimentary tract and metabolism, including antidiabetics - A10) as well as in the ATC groups B, C, G, J and S (blood and blood forming organs, cardiovascular system, genito urinary system, antiinfectives for systemic use and sensory organs). The prevalence of diabetic complications was: retinopathy 20%, polyneuropathy 15%, nephropathy 12%. Coronary heart disease had 34% (previous or newly diagnosed myocardial infarction 9%) of the diabetics. The mean HbA1c was 7.16% (normal range 4.4-6.4%); 34% had HbA1c levels >7.5%. In regression analysis, predictive factors for prescription costs in diabetics were age, systolic blood pressure, fasting plasma glucose (FPG), triglycerides and myocardial infarction (MI); factors influencing duration of hospital stays were FPG and MI. In control patients, only a correlation between body mass index as well as duration of hospital stays and total costs of prescriptions was found. Drugs without a sufficient evidence to improve the clinical outcome in diabetics, such as acarbose and thioctic acid, amounted to 7% of the total drug costs in diabetic patients.

Conclusion

The analysis and quality control of the treatment of diabetic patients in the general practice were helpful to evaluate the outcomes of the own therapy habits and showed requirements to optimise the therapy as well as potential for cost savings.